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1998 HSAC Forum <br />Table 1. HMOs: New Opportunities and Challenges <br />Opportunities <br />Greater emphasis on prevention and health <br />promotion <br />Less use of expensive tests and treatments <br />Greater coordination of care <br />Roughly comparable quality of care <br />Reduced financial barriers <br />Greater emphasis on measuring quality <br />2 <br />Challenges <br />Restricts choice of providers <br />Reported access barriers to specialists and <br />expensive tests and technology <br />Shifts financial risk of caring for patients to <br />providers <br />More difficult for providers to act as patients' <br />advocates <br />loosened under special circumstances; and, appeal /grievance proceedings <br />have been specified. Such legislation requires the support of an advocate <br />within the legislature as well as publicity and citizen support. Insurance and <br />small business lobbies generate a strong case. Right now, smaller human <br />services programs such as CHIP that provide stop -gap services for many <br />constituents are in danger from reduced funding. Counties often have to <br />pick up the tab for inadequate programs. Ultimately, though, the legislature <br />listens to what the people tell them. <br />Adam Searing of the NC Health Access Coalition also enthusiastically <br />endorsed advocacy as a method of creating change on behalf of the consumer <br />perspective. He has found that health issues can often (although not always) <br />elicit bipartisan support. The voice most often heard is big business: <br />consumers must also take a stand. Broad coalitions and the media are also <br />useful tools within politics and healthcare. He also described the differences <br />between legislative packages that may not cover all the gaps. <br />Allen Hamrick -UNC Student Health Services, Moses Carey- Piedmont <br />Health Services, and Florence Soltys and Audreye Johnson with the UNC <br />School of Social Work all made short presentations before participating in a <br />panel discussion regarding the "Views from Service Providers: Roles and <br />Responsibilities of Government and Non - Profit Agencies." Dr.? Hamrick <br />endorsed the necessity of creating an infrastructure to meet the needs of the <br />mentally ill. Managed care presents unusual challenges to psychiatric <br />patients who need to stay with a consistent care provider. It is sometimes <br />easier to admit a patient to a hospital than to provide preventive care. Dr.? <br />Carey talked about the role of the "safety -net providers" in protecting the <br />disenfranchised. Overall, the impact of managed care has been negative for <br />